Case Report : A Case of Spontaneous Subdural Hematoma in a Patient with Autosomal Dominant Polycystic Kidney Disease

( Won Ik Jang ),신영태 ( Young Tai Shin ),함영록 ( Young Rok Ham ),정지윤 ( Ji Yoon Jung ),장동석 ( Dong Suk Chang ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: Intracranial manifestations associated with autosomal dominant polycystic kidney disease (ADPKD) include arachnoid cysts, dolichoectasias, and subdural hematoma (SDH), although there are only a few reports of SDH in patients with ADPKD. We report a case of spontaneous SDH in a patient with ADPKD. A 33-year-old woman complained of severe nausea and vomiting for 10 days. She had suffered from a headache for several months. She was diagnosed with ADPKD and hypertension 6 years earlier, and the hypertension was well controlled. Her mental state was drowsy in the emergency room. Her blood pressure was 180/105 mmHg. There was no evidence of head trauma. Results of a peripheral blood CBC and blood chemistry analysis were within normal limits, as were the results of a blood coagulation test and urinalysis. She was pregnant and in the eighth week of gestation. Brain magnetic resonance imaging revealed SDH in the left lateral convexity and focally in the right lateral convexity, and brain herniation. Surgical drainage was performed through a burr hole, under general anesthesia. Intra-operatively, 62 mL of liquefied subdural hematoma were removed. She recovered completely without sequelae.

성인에서 발생한 Henoch-Schonlein 신염의 예후인자

김난희 ( Nan Hee Kim ),함영록 ( Young Rok Ham ),윤지현 ( Ji Hyun Yoon ),정지윤 ( Ji Yoon Jung ),김의식 ( Eui Sik Kim ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

Purpose: Renal involvement of Henoch-Schonlein (HS) purpura is common, and the long-term prognosis depends on the degree of renal injury. The aim of our study was to search for prognostic factors of HS nephritis and its relationship with clinical, laboratory, and renal pathologic features. Methods: Study population consisted of 81 patients (age ≥15 years) with HS nephritis who had been admitted to Chungnam National University Hospital from January, 1991 to February, 2008. We reviewed the clinical symptoms, laboratory data and pathologic findings of kidney of total 81 patients, and also analyzed the relationship between these and renal prognosis. Results: The mean age of patients was 40.6 years and the median duration of follow-up was 16 months. Male to female ratio was 1.08. Kidney biopsies were carried out in 61 patients (75.4%). Regarding renal function, 14 (17.3%) of patients reached moderate to severe renal insufficiency, and 4 (4.9%) progressed to end-stage renal disease within 16 months (median, range 1.5-196 months) after diagnosis. Complete clinical remission was achieved in 26 patients (32.1%). The presence of gastrointestinal symptoms, relapse of purpura, hypertension, nephrotic syndrome, renal insufficiency, increased level of serum immunoglobulin A, and the magnitude of crescents and sclerotic glomeruli were significantly associated with poor renal prognosis (all p<0.05). In multivariate logistic regression analysis, initial elevated serum creatinine level and hypertension were independent prognostic factors (p=0.013, p=0.007). Conclusion: We concluded that the initial clinical findings including renal function and hypertension are important prognostic factors in adult HS nephritis.

지속적 신대치요법 (Continuous Renal Replacement Therapy)으로 치료받은 급성 신부전증 환자들의 예후 인자

김의식 ( Eui Sik Kim ),함영록 ( Young Rok Ham ),장원익 ( Won Ik Jang ),정지윤 ( Ji Yoon Jung ),권오경 ( O Kyoung Kwon ),정사라 ( Sarah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1

Purpose: Continuous renal replacement therapy (CRRT) has been used widely for treating critically ill patients with acute renal failure (ARF). We performed this study to identify predictors of mortality in critically ill ARF patients treated with CRRT. Methods: We analyzed the data of 128 patients who were treated with continuous veno-venous he-mofiltration (CVVH) or continuous veno-venous hemodiafiltration (CVVHDF) from May, 2002 to March, 2008. We compared the clinical data of survivors with non-survivors. Results: On univariate analyses of prognostic factors of patients treated with CVVHDF, APACHE II scores (p=0.004), prothrombin time (INR) (p=0.033) and the number of inotropics used (p=0.005) were significantly lower in survivors than those of non-survivors. MAP (p=0.027), diastolic BP (p=0.015) and fibrinogen level (p=0.007) were significantly higher in survivors than those of non-survivors. Multivariate analysis revealed that APACHE II scores and fibrinogen level were the independent factors for the prediction of mortality. And on univariate analyses of prognostic factors of patients treated with CVVH, APACHE II scores (p=0.002) and the number of inotropics used (p=0.006) were significantly lower in survivors than in non-survivors. MAP (p=0.03), systolic BP (p=0.02) and diastolic BP (p=0.03) were significantly higher in survivors than in non-survivors. Multivariate analysis also revealed that APACHE II scores was the only independent factor for the prediction of mortality. Conclusion: This study showed that the independent prognostic factor for mortality in ARF patients treated with CRRT was the APACHE II score.

혈액투석치료를 받는 말기신부전 환자에서 체내 수분분포와 임상상

장원익 ( Won Ik Jang ),배홍진 ( Hong Jin Bae ),함영록 ( Young Rok Ham ),장동석 ( Dong Suk Chang ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3

Purpose: Maintenance of the normal hydration state is one of the major purposes of hemodialysis therapy in patients with end-stage renal disease. Overhydration is an important and independent predictor of mortality in patients with end-stage renal disease on regular hemodialysis. BCM (body composition monitor, FMC, Germany) reliably enables quantitative assessment of hydration status and body composition. The aims of this study were to investigate the relationship between hydration status and clinical features and the risk factors of overhydration. Methods: We measured hydration status and body composition of total 72 patients with end-stage renal disease on regular hemodialysis by BCM from June, 2009 to September, 2009. We also reviewed the clinical characteristics and laboratory findings and comorbidities retrospectively. Results: The hydration status measured by BCM was correlated well with interdialytic weight gain after 48 hours and 72 hours from last hemodialysis treatment (r=0.42 p<0.001, r=0.38 p<0.01, respectively). There was no statistically significant difference in comorbidities, age, sex, BMI, blood pressure, hypotensive episodes between the patients with overhydrated state (relative hydration status ≥20%) and control patients (relative hydration status <20%). In overhydrated patients, serum iron level was lower than control patients 48 hrs after last hemodialysis (p<0.05). Conclusion: This cross-sectional study showed that hydration status measured by BCM was correlated well with interdialytic weight gain although there was no significant clinical difference between overhydrated and control patients with end-stage renal disease on regular hemodialysis

투석환자에서 Ankle-Brachial Index를 이용한 말초혈관질환의 위험인자 분석

이강욱 ( Kang Woo Lee ),정지윤 ( Ji Yoon Jung ),함영록 ( Young Rok Ham ),장원익 ( Won Ik Jang ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: Peripheral arterial disease (PAD) is a predictable marker of coronary heart disease and cerebrovascular disease and its prevalence among chronic kidney disease (CKD) patients especially in end-stage renal disease (ESRD) patients undergoing dialysis is apparently increasing. Ankle-brachial index (ABI) is regarded as an easy, reliable, and noninvasive measure of the presence and severity of lower-extremity PAD (ABI<0.9). The aims of this study are to find out the prevalence of lower limb PAD measured by ABI, and to assess the risk factors of PAD in patients with ESRD. Methods: One hundred thirty eight ESRD patients from May 2005 to September 2009 who were performed ABI examination were categorized into PAD (ABI<0.9) or non-PAD (ABI≥0.9) and the prevalence of PAD was analyzed. We measured ABI with VP2000 PWV/ankle-brachial index. We also reviewed the clinical characteristics and evaluated the risk factors of PAD, retrospectively. Results: One hundred seventeen patients on hemodialysis, and twenty one patients on peritoneal dialysis were included in this study. The mean age of total patients was 60.1 (24-84) years old. Thirty five patients out of one hundred thirty eight patients had an ABI index of less than 0.9 (PAD indicative). PAD was independently associated with age (p=0.013), duration of dialysis (p=0.013), history of coronary artery disease and cerebrovascular disease (p=0.001, p=0.001 respectively), diabetes (p= 0.034), and increased LDL cholesterol (p=0.004) in univariate analysis. In multivariate logistic regression analysis, duration of dialysis, increased level of LDL-cholesterol and history of coronary artery disease were significantly related with PAD (p=0.008, p=0.019, p=0.018 respectively). Conclusion: Duration of dialysis, increased level of LDL-cholesterol and coronary artery disease were independent risk factors for PAD in patients with ESRD on dialysis.